A Double-Skin Paddle Radial Forearm Flap for the Reconstruction of Oral Submucous Fibrosis

Abstract

Objective: Oral submucous fibrosis can result in progressive restriction of mouth opening. Surgical treatment is indicated for severe cases. An innovative technique, a double-skin paddle radial forearm flap, using only one forearm donor site to reconstruct the bilateral buccal defects, is described. Patients and Methods: A total of six patients, having severe oral submucous fibrosis, were treated between July 2002 and August 2004. The surgical procedure consists of (1) release of all the intraoral fibrotic tissue, (2) masticatory muscle myotomy and coronoidotomy, and (3) reconstruction with a double-skin paddle radial forearm flap. Results: The preoperative mouth opening was 2 to 5 mm (mean: 3.3 mm). The intraoperative mouth opening ranged from 13 to 20 mm (mean 16.5 mm) after submucous release and ranged from 32 to 42 mm (mean 35.5 mm) after further release via myotomy and coronoidotomy. The proximal flap incorporated one perforator in two patients and two perforators in the remaining 4 patients. The size of the flaps ranged from 8 to 9 cm in length and 2 to 2.5 cm in width. Five flaps survived uneventfully. Arterial thrombosis, developing 24 hours after the operation, was noted in one flap. The flap was successfully salvaged after emergent exploration. Temporomandibular joint subluxation developed in one patient and required surgical reduction. One patient needed flap revision due to bulkiness. The postoperative mouth-opening range was 22 to 37 mm (mean: 30 mm) at an average follow-up period of 19 months. The average increase of the mouth opening was 26.7 mm, compared with the preoperative interincisor distance. Conclusion: Double-skin paddle radial forearm flap allowed simultaneous reconstruction of two separate buccal defects using a single donor site and thus obviates the need for a second free flap.